Surveillance for pneumoconioses requires a test with reasonable sensitivity and specificity coupled with preventive interventions for the individual worker as well as the work place in general. The International Labor Organization (ILO) System to Classify Chest Radiographs for Pneumoconioses (ICRP) is well established as an epidemiologic tool. The current system requires the use of 22 films. Access to these films is limited due to the cost of reproduction, distribution, and importantly the complexity of the system which requires greater than necessary investments in training and application. Increasingly, the industrialized and industrializing world has a need for a simple, easy to use, cost effective tool to classify radiographs for pneumoconiosis. We seek to validate the use of a simple set of 7 radiographs as a Surveillance Radiograph Standards Set (SRSS) to classify small opacity profusion, size and shape. Because this is a tool for pneumoconiosis surveillance, the validation will be not just for classifying radiographs, but to test the field application of the SRSS as part of surveillance exercise. The specific aims are to test the hypotheses: 1) Use of the seven film SRSS can categorize chest radiographs as normal or abnormal (abnormal defined as profusion categories 1/1 or greater) with a sensitivity and specificity of 65% and 2) Use of a seven film SRSS can classify chest radiographs according to profusion and shape with profusion being correctly categorized exactly in 40% and within one minor category in 65% of films classified; and 3) Develop and validate a model training curriculum and examination to develop and test the knowledge skills and competencies of physicians using the surveillance test set.